Elderly and the Flu: Going Beyond Vaccinations

The Centers for Disease Control and Prevention estimate that 30,000 people die annually from the flu. The vast majority of those deaths are among older people age 65 and older.

While the flu vaccine will offer protection, Dr. Christopher Crnich, an infectious-disease specialist and associate professor of medicine at the University of Wisconsin School of Medicine and Public Health, said older people need to take more precautions to avoid getting sick.

"There is a long-standing impression that our current flu vaccine is very protective in older adults," he said. "The reality is it's probably not as effective as we would like it to be. The mindset that we are going to take care of the problem just by vaccinating older people is overly simplistic."

Crnich said along with getting vaccinated, older adults should avoid contact with friends and loved ones who are sick. Even better would be the family and friends of older people getting vaccinated themselves.

"Family members and loved ones should get vaccinated to protect the older adults," he said. "At nursing homes, we have been doing a very good job of vaccinating older adults for about a decade, and facilities with high rates of vaccinated employees have much lower rates of influenza, and fewer complications and hospitalizations as compared to facilities with lower rates of vaccinated employees. The conclusion is if you can vaccinate the people who are able to mount a very potent immune response, that's going to further protect the older adults who are not able to mount that much resistance to influenza."

Crnich said older adults should wash their hands frequently with soap and water or a waterless gel, and stay a reasonable distance away from those who are infected if they must be around other people who are ill.

"The danger zone is usually three to five feet," he said. "Influenza is transmitted by aerosol droplets, and they don't travel well beyond that distance. If you are at a gathering where people are ill, it would be helpful to stay outside that danger zone."

Because younger children often carry flu viruses that they pick up from playmates, Crnich recommends that older adults stay a safe distance from sick kids.

"That can be challenging," he acknowledges. "I'm not saying people should lock themselves in their homes during flu season. But they should be aware of such things."

Crnich said research has been going on for decades on why the body's immune system seems to diminish with age. But even within that age group, people with chronic health problems such as heart disease and diabetes are probably going to have reduced immunity to the flu versus those who lead more active lifestyles.

"A very robust, physically active older adult more than likely has a strong immune system," he said. "If an older adult has chronic medical conditions or a number of physical impairments, and they require assistance with their daily activities, it's more than likely their immune system has weakened, and they may not have a protective immune response to vaccines."

Crnich said research is currently underway on a high-dose vaccine that could offer more protection to older adults than the standard dose. Trials involving the higher dose have been promising so far.

"The high dose has been shown to have a better immune response to antigens than the standard dose in older adults," he said. "Right now, studies are trying to determine if the higher dose results in better health outcomes. That may take one or two more years."

"There could be local reactions to the high-dose vaccine, meaning more soreness and redness where the shot is given," Crnich added. "Beyond that, the side effects are very minimal and well tolerated. I think we can say confidently that the higher dosage is just as safe as the lower dosage."